OBJECTIVE

This study determined which of the anti-vascular endothelial growth factors (anti-VEGF) agents is the most cost-effective in treating patients with diabetic macular edema (DME).

This study was a cost-effectiveness analysis. A decision-analytic Markov cohort model of the natural history and treatment of DME was developed. Data was obtained from a meta-analysis by Virgili et al. on anti-VEGFs for DME in which intravitreal injections of bevacizumab given monthly, 6-weekly, and 12-weekly; ranibizumab given monthly, bimonthly, and as necessary; aflibercept given monthly, bimonthly, and as necessary; and macular laser therapy were evaluated for efficacy and safety in 4,413 eyes. Costs were obtained from local standard retail price at a tertiary government institution and assumed an out-of-pocket expenditure. The study measured and compared gains in quality-adjusted life years (QALYs) and incremental costeffectiveness ratios (ICERs) for each treatment regimen.

Quarterly bevacizumab, monthly ranibizumab (3.82 QALY), and bimonthly ranibizumab injections were the three most beneficial dosing schedules in terms of clinical effectiveness at 3.81, 3.82, and 3.89 QALY, respectively. However, in terms of cost, bevacizumab was substantially most affordable. Quarterly dosing of bevacizumab provided the best value for money, with an ICER of PhP 9,661.70 per QALY gained.

Quarterly intravitreal injections of bevacizumab were identified as the most cost-effective treatment regimen for DME. To be considered cost-effective alternatives, ranibizumab requires an 85% price reduction, while aflibercept needs a price reduction exceeding 95%. We recommend quarterly bevacizumab injections be included in the national insurance coverage package, given their cost-effectiveness and clinical efficacy in the treatment of DME.

We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.
Humans ; Female ; Middle Aged ; Endothelial Growth Factors ; Intravitreal Injections ; Case Management ; Carcinoid Tumor/pathology*

Diabetic retinopathy(DR)is the major microvascular disease in diabetic patients,and it is also one of the main blinding eye diseases in the current population.The typical pathological change of DR in the eyes is vascular endothelial growth factor(VEGF)-mediated neovascularization induced by retinal ischemic stimulation.Therefore,anti-VEGF drugs have gradually become one of the mainstream methods to treat DR and DR-induced diseases such as diabetic macular edema.Recent studies have proved that anti-VEGF drugs have certain effects on ocular blood vessels and blood flow in patients with DR,while the specific mechanism has not been fully elucidated.This article summarizes the research progress on the effects of intravitreal injection of anti-VEGF drugs on the ocular blood vessels and blood flow in patients with DR.
Angiogenesis Inhibitors/therapeutic use* ; Diabetes Mellitus ; Diabetic Retinopathy/drug therapy* ; Humans ; Intravitreal Injections ; Macular Edema/drug therapy* ; Pharmaceutical Preparations ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors/therapeutic use*

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Acyclovir ; Anterior Chamber ; Ganciclovir ; Hand ; Herpesvirus 3, Human ; Humans ; Intravitreal Injections ; Light Coagulation ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retinal Necrosis Syndrome, Acute ; Retinal Vessels ; Retinaldehyde ; Retinitis ; Silicon ; Silicones ; Visual Acuity ; Vitrectomy

PURPOSE: To compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME).METHODS: Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months.RESULTS: After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034).CONCLUSIONS: In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.
Bevacizumab ; Dexamethasone ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema ; Recurrence ; Retreatment ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare the outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implants and intravitreal bevacizumab injections.METHODS: A retrospective cohort study was designed using 66 patients with DME treated with intravitreal dexamethasone (n = 35; 35 eyes) and intravitreal bevacizumab (n = 31; 31 eyes). Post-treatment changes in hyperreflective foci in the inner and outer retina were characterized using optical coherence tomography, central macular thickness, outer limiting membrane, and photoreceptor inner segment-outer segment junctions. Visual acuities were analyzed 4 weeks after bevacizumab injections and 8 weeks after dexamethasone injections.RESULTS: Both groups showed a decrease in the number of hyperreflective foci after treatment: from 10.6 ± 11.8 to 6.3 ± 5.9 (p = 0.005) in the intravitreal dexamethasone implant group and from 11.6 ± 8.5 to 7.7 ± 6.7 (p < 0.001) in the intravitreal bevacizumab injection group. The mean central macular thickness in the dexamethasone group changed significantly from 586.8 µm to 297.7 µm after treatment and the visual acuity improved significantly from 0.33 logMAR to 0.38 logMAR after treatment (p < 0.001 and p = 0.018, respectively). The mean central macular thickness in the bevacizumab group showed a significant decrease from 467.1 µm to 353.2 µm after treatment (p < 0.001), but there was no significant change in the visual acuities: 0.34 logMAR to 0.32 logMAR after treatment (p = 0.464).CONCLUSIONS: Both intravitreal dexamethasone implants and bevacizumab treatments in patients with DME showed improved outcomes including a decrease in hyperreflective foci shown by optical coherence tomography.
Bevacizumab ; Cohort Studies ; Dexamethasone ; Humans ; Intravitreal Injections ; Macular Edema ; Membranes ; Retina ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To compare the intraocular pressure (IOP) in diabetic macular edema (DME) patients and macular edema associated with branch retinal vein occlusion (BRVO) patients after intravitreal preservative-free Triamcinolone injection.METHODS: This study included 36 patients diagnosed with DME and 44 patients diagnosed with BRVO with macular edema. Both groups were treated with intravitreal preservative-free Triamcinolone (Maqaid®, Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan) injection, and we compared the IOPs of the two groups determined before injection and at 1, 2, 3, and 6 months after injection. We also compared the IOP elevation ratios and durations, and central foveal thickness (CFT) changes using optical coherence tomography.RESULTS: In both groups, there was no statistical significance in the IOP before injection and at 1, 2, 3, and 6 months after injection. However, the IOP elevation ratio in the DME patients (38.9%) was significantly higher than that in the BRVO patients (15.9%) (p = 0.02). The duration of IOP elevation in the DME patients (1.14 ± 1.85 months) was significantly longer than that in the BRVO patients (0.30 ± 1.20 months) (p = 0.03). When the IOP was not controlled, we used IOP-lowering agents, and two patients in the DME were treated with glaucoma surgery. There was no statistical significance in the CFT before injection and at 1, 2, or 3 months after injection between the two groups (p = 0.72, p = 0.26, p = 0.66, p = 0.34, respectively). However, the CFT after 6 months was 328 ± 103 µm in the DME group and 434 ± 189 µm in the BRVO; this difference was significant (p < 0.01).CONCLUSIONS: Intravitreal injection of preservative-free Triamcinolone was effective in the treatment of both DME patients and macular edema patients associated with BRVO. Furthermore, Triamcinolone was more safely injected in macular edema associated with BRVO patients than in DME patients.
Glaucoma ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Retinal Vein Occlusion ; Retinal Vein ; Retinaldehyde ; Tomography, Optical Coherence ; Triamcinolone

intravitreal anti-vascular endothelial growth factor (VEGF) injections on ganglion cell-inner plexiform layer (GCIPL) thickness in patients with age-related macular degeneration (AMD).METHODS: This retrospective study included patients with continuous anti-VEGF treatment who were administered at least three consecutive injections for unilateral neovascular AMD. The GCIPL thickness of the study eyes was compared before and after treatment and with healthy fellow eyes using spectral-domain optical coherence tomography. We also evaluated best-corrected visual acuity, age, and intraocular pressure.RESULTS: In total, 96 eyes of 48 patients (14 females and 34 males; mean ± standard deviation [SD] age, 70.10 ± 8.89 years) with mean number of 6.29 (SD ± 3.76) anti-VEGF injections and a mean follow-up period of 24.93 months (SD ± 19.86) were included in the study. After three consecutive intravitreal injections of anti-VEGF, the mean GCIPL thickness was significantly reduced from 70.50 (SD ± 14.06) to 65.97 (SD ± 13.91) µm. Borderline or nonsignificant decrease was also observed in GCIPL thickness for each sector. At the end of the study, the mean GCIPL thickness was further reduced to 62.56 (SD ± 16.30) µm, and significant decreases were also observed in all other sectors compared with baseline.CONCLUSIONS: It has been observed that GCIPL thickness can decrease with only three consecutive anti-VEGF injections as well as with long-term treatment in AMD patients.]]>
Endothelial Growth Factors ; Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Degeneration ; Male ; Ranibizumab ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

No abstract available.
Ceftazidime ; Endophthalmitis ; Humans ; Intravitreal Injections ; Vancomycin

PURPOSE: To compare long-term refractive outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) versus laser photocoagulation treatment for retinopathy of prematurity (ROP). METHODS: A total of 52 eyes from 27 ROP patients treated at two tertiary referral-based hospitals from August 2006 to December 2013 were reviewed. The primary outcome was refractive error measured at the age of 4 years, accounting for within-patient inter-eye correlation. Secondary outcomes included the recurrence rate and treatment complications. RESULTS: The mean age at refraction was 4.7 ± 0.3 years in the laser group (n = 30) and 4.4 ± 0.3 years in the anti-VEGF group (n = 22). No significant differences were noted in gestational age, birthweight, post-menstrual age at treatment, or ROP stage/zone distribution between groups. Mean spherical equivalent was also not significantly different (−1.0 diopters in the laser group and −0.3 diopters in the injection group, p = 0.603). Clustered regression analysis revealed that only gestational age was significantly correlated with mean spherical equivalent (p < 0.001; 95% confidence interval, −0.007 to −0.002). Recurrence was noted in four eyes (13.3%) in the laser group, but this difference was not significant (p = 0.128). There were no major systemic complications reported in either group. CONCLUSIONS: Treatment type, whether laser or anti-VEGF injection, does not appear to influence long-term refractive outcomes in ROP. Concern regarding refractive outcomes should not be the most important factor when selecting ROP treatment modality.
Child ; Child, Preschool ; Endothelial Growth Factors ; Gestational Age ; Humans ; Intravitreal Injections ; Laser Therapy ; Light Coagulation ; Recurrence ; Refractive Errors ; Retinopathy of Prematurity ; Vascular Endothelial Growth Factor A